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Generic Name: sotalol (SOE ta lol)
Brand Name: Betapace, Sorine, Sotylize

What is sotalol?

Sotalol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Sotalol is used to help keep the heart beating normally in people with certain heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). Sotalol is used in people with ventricular tachycardia or ventricular fibrillation.

Another form of this medicine, called sotalol AF, is used to treat heart rhythm disorders of the atrium (the upper chambers of the heart that allow blood to flow into the heart). Sotalol AF is used in people with atrial fibrillation or atrial flutter.

Sotalol (Betapace, Sorine, Sotylize) is not used for the same conditions that sotalol AF (Betapace AF) is used for.

Sotalol may also be used for purposes not listed in this medication guide.

What is the most important information I should know about sotalol?

You will receive your first few doses of sotalol in a hospital setting where your heart can be monitored in case the medicine causes serious side effects.

Slideshow: Atrial Fibrillation - Stroke Prevention Guidelines & Treatment Options

You should not use sotalol if you have asthma, certain serious heart conditions, or a history of Long QT syndrome.

What should I discuss with my healthcare provider before taking sotalol?

You should not use this medicine if you are allergic to sotalol, or if you have:

  • a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker);

  • severe heart failure (that required you to be in the hospital);

  • asthma or other breathing disorder;

  • low levels of potassium in your blood;

  • severe kidney disease;

  • a personal or family history of Long QT syndrome; or

  • a history of slow heart beats that have caused you to faint.

To make sure sotalol is safe for you, tell your doctor about your other medical conditions, especially:

  • breathing problems such as bronchitis or emphysema;

  • a history of heart disease or congestive heart failure;

  • coronary artery disease (hardened arteries);

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • diabetes;

  • kidney disease;

  • a thyroid disorder;

  • a history of allergies; or

  • if you have recently had a heart attack.

Sotalol is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Sotalol can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using sotalol.

How should I take sotalol?

You will receive your first few doses of sotalol in a hospital setting where your heart can be monitored in case the medication causes serious side effects.

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take sotalol at the same time every day.

Do not skip doses or stop using sotalol without your doctor's advice. Stopping suddenly may make your condition worse. Follow your doctor's instructions about tapering your dose.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

While using sotalol, you may need frequent blood tests. Your heart function may need to be checked using an electrocardiograph or ECG (sometimes called an EKG).

You may have very low blood pressure while taking this medicine. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. Prolonged illness can lead to a serious electrolyte imbalance, making it dangerous for you to use sotalol.

If you need surgery or medical tests, tell the doctor ahead of time that you are using sotalol. You may need to stop using the medicine for a short time.

Sotalol (Betapace, Sorine, Sotylize) and sotalol AF (Betapace AF) are not the same medicine. Always check your medicine when it is refilled to make sure you have received the correct brand and type as prescribed by your doctor. Ask the pharmacist if you have any questions about the medicine given to you at the pharmacy.

If there are any changes in the brand or strength of sotalol you use, your dosage needs may change.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 8 hours away. Do not take extra medicine to make up the missed dose.

Use sotalol regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking sotalol?

Avoid taking an antacid within 2 hours before or 2 hours after you take sotalol. Some antacids can make it harder for your body to absorb sotalol.

Sotalol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

  • slow heartbeats;

  • a light-headed feeling, like you might pass out;

  • trouble breathing;

  • severe diarrhea or vomiting, loss of appetite;

  • dry mouth, unusual sweating, increased thirst; or

  • swelling, rapid weight gain.

Common side effects may include:

  • headache;

  • dizziness;

  • tired feeling; or

  • slow heartbeats.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Sotalol dosing information

Usual Adult Dose for Atrial Fibrillation:

Note: The generic form of this drug is used for atrial fibrillation or ventricular arrhythmia. The trade name Betapace (R) is for ventricular arrhythmia only and the trade name Betapace AF (R) is for atrial fibrillation only. These two trade names are not interchangeable.

SOTALOL: (ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA):
-Initial dose: 80 mg orally 2 times a day
-Doses should be adjusted gradually every 3 days in order to attain steady state plasma concentrations and allow for monitoring of QT intervals.
-Maintenance dose: The initial dose may be increased, if needed, to 240 or 320 mg orally per day (120 to 160 mg orally 2 times a day).
-Some patients with life-threatening refractory ventricular arrhythmias may require 480 to 640 mg per day in divided doses.
Comment:
-Because of the long terminal elimination half-life of this drug, dosing on more than a twice a day regimen is usually not necessary.

ORAL [BETAPACE AF (R)}: (ATRIAL FIBRILLATION):
-(STEP 1) Electrocardiographic assessment: Prior to administration of the first dose, the CrCl and the QT interval should be determined. If the baseline QT is greater than 450 msec, Betapace AF (R) is contraindicated:
-(STEP 2): Calculate the CrCl for the patient.
-(STEP 3):
Initial dose:
-If the CrCl is less than 40 mL/day: Betapace AF (R) is contraindicated
-If the CrCl is 40 to 60 mL/min: 80 mg once a day
-If the CrCl is greater than 60 mL/min: 80 mg orally 2 times a day
-(STEP 4): Continuous ECG monitoring with QT interval measurements should begin after the first dose and every 2 to 4 hours after each additional dose.
-(STEP 5); If the 80 mg dose level is tolerated and the QT interval remains less than 500 msec after at least 3 days (after 5 or 6 doses if patient receiving once-daily dosing), the patient can be discharged. Alternatively, during hospitalization, the dose can be increased to 120 mg twice daily and the patient followed for 3 days on this dose (followed for 5 or 6 doses if patient receiving once-daily dosing).
-If the 80 mg dose level (given twice a day or once-daily depending upon CrCl) does not reduce the frequency of relapses of atrial fibrillation/atrial flutter and is tolerated without excessive QT interval prolongation (i.e., greater than or equal to 520 msec), the dose level may be increased to 120 mg (twice a day or once-daily depending upon CrCl).
-If the 120 mg dose does not reduce the frequency of early relapse of atrial fibrillation/atrial flutter and is tolerated without excessive QT interval prolongation (greater than or equal to 520 msec), an increase to 160 mg (2 times a day or daily) depending upon CrCl), can be considered.
-Any increases in dosage should be done in a step-wise fashion as outlined above.
-Maintenance dose: 120 to 160 mg orally 2 times a day. Renal function and QT should be reevaluated regularly if medically warranted. If QT is 520 msec or greater (JT 430 msec or greater if QRS is greater than 100 msec), the dose should be reduced and patients should be carefully monitored until QT returns to less than 520 msec. If the QT interval is greater than or equal to 520 msec while on the lowest maintenance dose level (80 mg) the drug should be discontinued.

PARENTERAL:
-Initial: 112.5 mg IV once or twice daily
-Maintenance: 112.5 to 150 mg IV once or twice daily
-If 112.5 mg IV once or twice daily, at steady state, does not reduce the frequency of early relapse of arrhythmia and is tolerated without excessive QTc prolongation (greater than 520 msec), increase the dose to 150 mg IV once or twice daily.
-Start IV therapy only if the baseline QT interval is less than 450 msec. During initiation and titration, monitor the QT interval after the completion of each infusion. If the QT interval prolongs to 500 msec or greater, reduce the dose, decrease the infusion rate, or discontinue the drug.

Use: For the maintenance of normal sinus rhythm [delay in time to recurrence of atrial fibrillation/atrial flutter (AFIB/AFL)] in patients with symptomatic AFIB/AFL who are currently in sinus rhythm.

Usual Adult Dose for Atrial Flutter:

Note: The generic form of this drug is used for atrial fibrillation or ventricular arrhythmia. The trade name Betapace (R) is for ventricular arrhythmia only and the trade name Betapace AF (R) is for atrial fibrillation only. These two trade names are not interchangeable.

SOTALOL: (ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA):
-Initial dose: 80 mg orally 2 times a day
-Doses should be adjusted gradually every 3 days in order to attain steady state plasma concentrations and allow for monitoring of QT intervals.
-Maintenance dose: The initial dose may be increased, if needed, to 240 or 320 mg orally per day (120 to 160 mg orally 2 times a day).
-Some patients with life-threatening refractory ventricular arrhythmias may require 480 to 640 mg per day in divided doses.
Comment:
-Because of the long terminal elimination half-life of this drug, dosing on more than a twice a day regimen is usually not necessary.

ORAL [BETAPACE AF (R)}: (ATRIAL FIBRILLATION):
-(STEP 1) Electrocardiographic assessment: Prior to administration of the first dose, the CrCl and the QT interval should be determined. If the baseline QT is greater than 450 msec, Betapace AF (R) is contraindicated:
-(STEP 2): Calculate the CrCl for the patient.
-(STEP 3):
Initial dose:
-If the CrCl is less than 40 mL/day: Betapace AF (R) is contraindicated
-If the CrCl is 40 to 60 mL/min: 80 mg once a day
-If the CrCl is greater than 60 mL/min: 80 mg orally 2 times a day
-(STEP 4): Continuous ECG monitoring with QT interval measurements should begin after the first dose and every 2 to 4 hours after each additional dose.
-(STEP 5); If the 80 mg dose level is tolerated and the QT interval remains less than 500 msec after at least 3 days (after 5 or 6 doses if patient receiving once-daily dosing), the patient can be discharged. Alternatively, during hospitalization, the dose can be increased to 120 mg twice daily and the patient followed for 3 days on this dose (followed for 5 or 6 doses if patient receiving once-daily dosing).
-If the 80 mg dose level (given twice a day or once-daily depending upon CrCl) does not reduce the frequency of relapses of atrial fibrillation/atrial flutter and is tolerated without excessive QT interval prolongation (i.e., greater than or equal to 520 msec), the dose level may be increased to 120 mg (twice a day or once-daily depending upon CrCl).
-If the 120 mg dose does not reduce the frequency of early relapse of atrial fibrillation/atrial flutter and is tolerated without excessive QT interval prolongation (greater than or equal to 520 msec), an increase to 160 mg (2 times a day or daily) depending upon CrCl), can be considered.
-Any increases in dosage should be done in a step-wise fashion as outlined above.
-Maintenance dose: 120 to 160 mg orally 2 times a day. Renal function and QT should be reevaluated regularly if medically warranted. If QT is 520 msec or greater (JT 430 msec or greater if QRS is greater than 100 msec), the dose should be reduced and patients should be carefully monitored until QT returns to less than 520 msec. If the QT interval is greater than or equal to 520 msec while on the lowest maintenance dose level (80 mg) the drug should be discontinued.

PARENTERAL:
-Initial: 112.5 mg IV once or twice daily
-Maintenance: 112.5 to 150 mg IV once or twice daily
-If 112.5 mg IV once or twice daily, at steady state, does not reduce the frequency of early relapse of arrhythmia and is tolerated without excessive QTc prolongation (greater than 520 msec), increase the dose to 150 mg IV once or twice daily.
-Start IV therapy only if the baseline QT interval is less than 450 msec. During initiation and titration, monitor the QT interval after the completion of each infusion. If the QT interval prolongs to 500 msec or greater, reduce the dose, decrease the infusion rate, or discontinue the drug.

Use: For the maintenance of normal sinus rhythm [delay in time to recurrence of atrial fibrillation/atrial flutter (AFIB/AFL)] in patients with symptomatic AFIB/AFL who are currently in sinus rhythm.

Usual Adult Dose for Ventricular Arrhythmia:

Usual Adult Dose: Ventricular Arrhythmia:
(CA, US):
Note: The generic form of this drug is used for atrial fibrillation or ventricular arrhythmia. The trade name Betapace (R) is for ventricular arrhythmia only and the trade name Betapace AF (R) is for atrial fibrillation only. These two trade names are not interchangeable.

SOTALOL: (ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA):
-Initial dose: 80 mg orally 2 times a day
-Doses should be adjusted gradually every 3 days in order to attain steady state plasma concentrations and allow for monitoring of QT intervals.
-Maintenance dose: The initial dose may be increased, if needed, to 240 or 320 mg orally per day (120 to 160 mg orally 2 times a day).
-Some patients with life-threatening refractory ventricular arrhythmias may require 480 to 640 mg per day in divided doses.

Comment:
-Because of the long terminal elimination half-life of this drug, dosing on more than a twice a day regimen is usually not necessary.

ORAL (BETAPACE): (VENTRICULAR ARRHYTHMIA):
-Initial: 80 mg twice daily
-The initial dose may be increased 120 to 160 mg twice daily. The dosage should be adjusted gradually allowing 3 days between dosing increments in order to attain steady-state plasma concentrations and to allow monitoring of QT intervals. Graded dose adjustment will help prevent doses that are higher than necessary to control the arrhythmia. Most patients obtain a therapeutic response with a total daily dose of 160 to 320 mg given in two or three divided doses.

PARENTERAL:
-Initial: 75 mg IV infused over 5 hours once or twice daily based on the creatinine clearance.
-Maintenance: 75 to 300 mg infused over 5 hours once or twice daily based on the creatinine clearance.
-The dose may be increased in increments of 75 mg/day every 3 days. Doses as high as 225 or 300 mg IV have been utilized in patients with refractory life-threatening arrhythmias.
-Start IV therapy only if the baseline QT interval is less than 450 msec. During initiation and titration, monitor the QT interval after the completion of each infusion. If the QT interval prolongs to 500 msec or greater, reduce the dose, decrease the infusion rate, or discontinue the drug.

Use: Documented life-threatening ventricular arrhythmia

What other drugs will affect sotalol?

Many drugs can interact with sotalol. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with sotalol, especially:

  • digoxin;

  • insulin or oral diabetes medicine;

  • blood pressure medication; or

  • any other medicine that contains sotalol.

This list is not complete and many other drugs can interact with sotalol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about sotalol.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 11.01. Revision Date: 2014-12-16, 11:49:25 AM.

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